SAGES Magazine

THE SOUTH AFRICAN GASTROENTEROLOGY REVIEW 2021 | VOLUME 19 | ISSUE 2 | 45 Background: Ten to 15% of patients with gastrointestinal (GIT) bleeding have an obscure (often small bowel) source and usually require chronic packed-cell transfusion or iron therapy. We investigated the effect of video capsule endoscopy (VCE) on packed-cell transfusion and intravenous (IV) iron prescriptions in patients with obscure GIT bleeding. Methods: We did a retrospective analysis of patients undergoing VCE at Groote Schuur Hospital. Patient demographics, capsule results and subsequent interventions were extracted from primary records. Data on packed-cell transfusion and IV iron prescriptions was obtained from theWestern Cape Blood Service and Groote Schuur hospital pharmacy respectively; for a period from one year before VCE to 2 years post-VCE. Results: Of 131 VCEs between 2011 and 2018, 96 patients received packed cells, IV iron or both during the pre- and post-VCE period. Median age was 65 years (IQR=35-80) and 53% were female. Seventy-two patients received a total of 282 units of packed-cells pre-capsule (mean 3.9 units/patient) and 167 units of packed-cells post-capsule (mean 2.3 units/patient) (OR=10, CI:4.3-27, p=0.000). Sixty-four patients received IV iron; with mean 1.3 scripts/patient (89/64) pre- capsule and 2.1 scripts/patient (140/64) post-capsule (OR=0.4, CI:0.18-0.9, p=0.018). After VCE, there was a non-significant trend towards more packed-cells (2.7 vs 1.8 units/patient) and more IV iron (2.3 vs 2.1 scripts/patient) in patients with a positive compared to a negative VCE, respectively (OR=1.26, CI:0.77-2, p=0.32). Eighty-eight of 96 patients (92%) were alive at 2 years post-VCE. Conclusion: Compared to the year before VCE, a significant decrease in packed-cell units was accompanied by a significant increase in IV iron scripts in the 2 years post-VCE; but post-VCE packed-cell or iron scripts did not differ by capsule result. This outcome is favourable despite on-going need for haemoglobin support. Packed-cell transfusion and intravenous iron trends in patients with obscure gastrointestinal bleeding TR Machiridza, M Setshedi, SR Thomson Division of Gastroenterology, Department of Medicine, University of Cape Town, Groote Schuur Hospital Indications for Oesophagogastroduodenoscopy at Princess Marina Hospital, Gaborone, Botswana: A retrospective cross-sectional study SM Mosenye 1 , K Motumise 1 , M Vanterpool Hector 1 , P Vuylsteke 2 , M Mosepele 2 , T Gaolathe 2 Princess Marina Hospital 1 , University of Botswana 2 Background: Oesophagogastroduodenoscopy (OGD) is a medical procedure that has its complications and cost. Referrals for OGD therefore should follow available guidelines. In an open access referral system as is the case in Princess Marina Hospital (PMH) with no country specific guidelines for OGD, some referrals may not be appropriate. Objectives: To review and document indications for OGD and evaluate them against current guidelines, and to review the endoscopic findings. Methods: Cross-sectional study using retrospective records of non- paediatric patients (over 12 years) referred for OGD at Princess Marina Hospital* from 1st January to 31st December 2019. Results: 741 patients [60.7% females and 39.3% males] had OGD done at Princess Marina Hospital. The mean age (±SD) was 51.5 (±16.6). The most common indications for OGD were epigastric pain (17.5%), upper GI bleed (15%), peptic ulcer disease (14.3%) and dysphagia (12%). Gastritis was the most common endoscopic finding (63.2%) followed by peptic ulcer disease (15.9%), hiatus hernia (12.6%) and oesophageal candidiasis (9.3%). The reviewed and documented indications for OGD were generally in keeping with available guidelines for upper GI endoscopy, with rare exceptions (chronic retching 0.1% and recurrent tonsillitis 0.1%). Conclusion: The most common indication and endoscopic finding of OGD at PMH in 2019 were epigastric pain and gastritis respectively. Almost all the indications followed international guidelines, suggesting that open access endoscopy is an acceptable practice. Limitations and Recommendations: Being retrospective, the study did not allow for documentation of risk factors for upper GI diseases and whether the patients were empirically treated prior to referral for OGD. A prospective study is recommended with documentation of risk factors and information on prior empiric treatment. *Main referral hospital and the only centre in Botswana where government patients are referred for OGD. SAGES